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General NPI Number Information
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NPI Number | 1326041229
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Entity Type | Organization
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Legal Business Name | ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 1800 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521
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Country | US
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Telephone | 217-464-2966
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Fax | 217-464-1616
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Provider Business Mailing Address
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Address Line | 3051 HOLLIS DR
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City | SPRINGFIELD
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State | IL
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Zip | 62704-7450
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Country | US
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Telephone | 217-464-2966
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Fax | 217-464-1609
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Authorized Official
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Title or Position | VP REVENUE CYCLE
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Name | MARK D EVARD
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Credential |
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Telephone | 217-492-9651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 0002592
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License Number State | IL
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